Motivational interviewing for reducing rehospitalisation and improving patient activation among patients with heart failure or chronic obstructive pulmonary disease: a randomised controlled trial

Abstract

Objectives: The aim is to evaluate the effects of a motivational interviewing-based intervention, Supporting Patient Activation in Transition to Home, on rehospitalisation and patient activation among patients with heart failure or chronic obstructive pulmonary disease.

Design: A randomised, controlled, analysis-blinded trial was conducted.

Setting: Participants were recruited from two hospitals in mid-Sweden and the intervention and interviews were conducted post-discharge.

Participants: 207 participants with heart failure or chronic obstructive pulmonary disease were recruited. Participants were randomised to receive five motivational interviewing sessions post-discharge (n=103) or a control group (n=104).

Outcome measures: Rehospitalisation within 180 days post-discharge was retrieved, and patient activation was assessed using the Patient Activation Measure at baseline, 30, 90 and 180 days post-discharge. We used a generalised estimating equation to assess the difference in the secondary outcome, patient activation, between the intervention group and the control group during the 180-day follow-up.

Results: No statistically significant differences between the groups were found for rehospitalisation (p=0.33 to 0.41) or patient activation over time (B=-1.67, -0.71 and -0.83 (95% CI -5.45 to 2.10, -4.06 to 2.64 and -4.28 to 2.62), respectively).

Conclusion: Post-discharge motivational interviewing to decrease rehospitalisation or support patient activation does not seem beneficial for patients with heart failure or chronic obstructive pulmonary disease. The high disease burden may have limited patient participation in the intervention.

Trial registration number: NCT02823795.

Keywords: Aged; Health Services; Health Services for the Aged; Nursing Care; Quality in health care.

Figure 1. Flow diagram of the study. The questionnaire was distributed at baseline (T0) and T1–T3. Analyses of baseline characteristics, clinical data, self-rated health and rehospitalisation included 207 patients, and analyses of Patient Activation Measure included 176 patients in total. MI, motivational interviewing.